Health Plan Weekly

With COVID Testing Set to Surge, Insurers Fret About Costs

While two separate administrations have now specified that health insurers must cover, without cost sharing, all COVID-19 tests used for individual diagnostic purposes, one trade group says that health plans are still getting stuck with the bill for workplace-related testing — and the problem is only going to get worse.

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Could Payers, Plan Sponsors Pick Retail ‘Dance Partners?’

In a series of recent moves, large retailers with pharmacy operations have struck deals with or acquired smaller companies with the aim of adding on-demand, retail clinics at national scale — and marketing them to health plans or employers. While storefront clinics aren’t new, especially in big box stores, health care insiders say the emphasis on selling to plans over consumers is novel, and that health plans may come to see such agreements as an essential benefit.

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Peter Johnson

UnitedHealthcare, Cigna Join ‘Virtual-First’ Health Plan Fray

UnitedHealthcare and Centene Corp. have added “virtual first” plan designs to their employer-sponsored offerings, becoming the latest commercial insurance giants to offer benefit designs built around virtual pri...
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Anthem Becomes Second Insurer to Ease 3Q MLR Worries

Anthem, Inc.’s third-quarter 2021 financial results — combined with UnitedHealth Group’s strong showing less than a week earlier — have helped to ease investors’ concerns about the Delta variant’s potential impact to insurers’ medical costs, according to equities analysts.

The Blue Cross Blue Shield insurer said on Oct. 20 that its medical loss ratio (MLR) was 87.7% for the quarter, beating the Wall Street consensus of 88.4%. Anthem’s “government business drove MLR upside, with commercial earnings below expectations — consistent with the pandemic pattern of more persistent commercial utilization and more COVID sensitivity/deferred care in Medicare/Medicaid,” Evercore ISI analyst Michael Newshel pointed out in a note to investors.

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News Briefs

✦ UnitedHealth Group will reprocess all of its commercial claims for COVID-19 vaccine administration after a federal investigation found the integrated health care giant paid providers less than 40% of the Medicare reimbursement rate for administering inoculations. Sen. Bob Casey, Jr. (D-Pa.), chair of the special committee on aging, wrote in a letter to UnitedHealth that it must inform the committee of the number of claims it expects to reprocess by Nov. 5. UnitedHealth will owe about $15 million for every 1 million claims it reprocesses, according to press reports.

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Telehealth SUD Treatment Needs More Research, Oversight

A growing amount of treatment for substance use disorders (SUDs) has moved to telehealth providers due to the COVID-19 pandemic. This trend likely increased patients’ access to treatment, among other benefits, but researchers and plan sponsors say that the efficacy and value of virtual care modalities in SUD settings is still an open question.

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UnitedHealth Reports Solid 3Q Despite Rising COVID Costs

UnitedHealth Group’s third-quarter 2021 financial results impressed Wall Street, with equities analysts describing the company’s performance as “solid across the board” and “generally positive” even though the company did see health care costs related to COVID-19 rise during the quarter.

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Air Ambulance Prices Grew Fast — and Will Likely Stay High

Air ambulances have been villainized in recent years for charging patients with surprise bills at eye-popping amounts. Comprehensive new research by FAIR Health confirms that air ambulance costs went up very fast — and experts say that even though surprise billing has been banned, high prices are here to stay.

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Consolidation in Payer, Provider Markets Continues to Rise

About 73% of health insurance markets in the metropolitan statistical areas were highly concentrated in 2020, while in 46% of those markets, a single insurer’s market share reached at least 50%, according to the 2021 edition of an annual report from the American Medical Association. The consolidation trend is also pronounced with providers, a trend that is likely to be accelerated due to revenue shortfalls caused by the pandemic. A Health Affairs study found that the share of primary care physicians affiliated with vertically integrated health systems increased from 38% in 2016 to 49% in 2018, while more than half of physicians and 72% of hospitals were affiliated with one of 637 health systems in 2018. Yet several studies suggested that there is no clear evidence that provider consolidation leads to higher quality of care.

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